Comparative effectiveness of gram-positive versus mixed antibiotic prophylaxis on surgical site infection rates following three-column osteotomy for adult spinal deformity

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-24 DOI:10.1016/j.clineuro.2025.109173

Sadegh Bagherzadeh , Navid Moghadam , Mohammad Rostami-Ravari , Pershang Nazemi , Zohreh Koohpayezadeh-Esfahani , Marzieh Rostami , Ricardo B.V. Fontes , Mohsen Rostami , P. Mitchell Johansen , Sawyer Bauer , Mark Greenberg , Puya Alikhani

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引用次数: 0

Abstract

Background

Surgical Site Infection (SSI) remains a major complication following spine surgery, particularly in complex procedures such as three-column osteotomies (3COs), where infection rates may reach up to 35 %. Standard perioperative antibiotic protocols primarily target gram-positive organisms, yet gram-negative bacteria have been increasingly implicated in SSIs, raising concerns about the adequacy of current prophylactic regimens. This study aims to evaluate whether the addition of gram-negative antibiotic coverage to standard gram-positive prophylaxis (Mixed Coverage, MC) reduces the incidence of SSI in adult patients with spinal deformity undergoing high-grade osteotomies.

Methods

We retrospectively analyzed 236 adult patients who underwent lumbar 3CO and spinopelvic fixation at a tertiary academic center. Patients were divided into two sequential cohorts based on a change in institutional antibiotic prophylaxis protocol: gram-positive coverage alone (GPC, n = 128) and combined gram-positive and gram-negative coverage (MC, n = 108). The primary endpoint was SSI occurrence, categorized as superficial or deep. Statistical comparisons included both univariate and multivariate analyses.

Results

Univariate analysis demonstrated a significantly lower SSI rate in the MC group (3 %) compared to the GPC group (10 %) (p = 0.03). However, after multivariate adjustment, the difference was not statistically significant (OR = 0.31, 95 % CI: 0.09 – 1.04, p = 0.059). Rates of deep infections (GPC: 2.4 %, MC: 0 %, OR = not estimable) and bacteremia (GPC: 3.9 %, MC: <1 %, OR = 4.1, p = 0.14) were also higher in the GPC group, though these differences did not reach statistical significance.

Conclusions

While univariate analysis suggests a potential benefit from adding gram-negative coverage, multivariate analysis did not confirm this effect. Larger prospective studies are needed to assess the efficacy and safety of expanded prophylactic regimens in high-risk spinal deformity surgery.

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革兰氏阳性与混合抗生素预防对成人脊柱畸形三柱截骨术后手术部位感染率的比较效果

手术部位感染（SSI）仍然是脊柱手术后的主要并发症，特别是在复杂的手术中，如三柱截骨术（3COs），感染率可高达35% %。标准的围手术期抗生素方案主要针对革兰氏阳性菌，但革兰氏阴性菌与ssi的关系日益密切，这引起了人们对当前预防方案是否足够的担忧。本研究旨在评估在标准革兰氏阳性预防（混合覆盖，MC）基础上增加革兰氏阴性抗生素覆盖是否能降低接受高级别断骨术的脊柱畸形成人患者的SSI发生率。方法回顾性分析236例在某三级学术中心行腰椎3CO和脊柱骨盆固定手术的成年患者。根据机构抗生素预防方案的变化，将患者分为两个顺序队列：单独革兰氏阳性覆盖率（GPC, n = 128）和革兰氏阳性和革兰氏阴性联合覆盖率（MC, n = 108）。主要终点是SSI的发生，分为浅表或深部。统计比较包括单变量和多变量分析。结果单因素分析显示，MC组SSI发生率（3 %）显著低于GPC组（10 %）（p = 0.03）。但多因素调整后，差异无统计学意义（OR = 0.31, 95 % CI: 0.09 - 1.04, p = 0.059）。GPC组的深度感染发生率（GPC: 2.4 %,MC: 0 %,OR =不可估计）和菌血症发生率（GPC: 3.9 %,MC: 1 %,OR = 4.1, p = 0.14）也高于GPC组，但差异无统计学意义。结论：虽然单因素分析表明增加革兰氏阴性覆盖有潜在的好处，但多因素分析并未证实这一效果。需要更大规模的前瞻性研究来评估扩大预防方案在高危脊柱畸形手术中的有效性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.